The rate of pregnancy-associated acute kidney injury (P-AKI) has dwindled in high income countries mainly following the legalization of abortion in the seventies and early eighties and the general improvement in obstetrical care. P-AKI has not however disappeared from high income countries and several reports indicate that its frequency has even increased during the last decade. The reasons for such evolution are probably an improved surveillance and reporting of P-AKI and a more aggressive approach to the treatment of pregnancy complications, with unintended renal side effects. The characteristics of pregnant women in high-income countries have also changed as the number of women with medical conditions, including diabetes and chronic kidney disease, has tended to increase. P-AKI in high income countries is still a matter of concern for nephrologists who have in mind that any rate, however low, of P-AKI remains unacceptable.